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Wong GYM, Diakos C, Molloy MP, Hugh TJ. Current Challenges in Defining Futile Liver Resection and Predicting Early Recurrence After Curative-Intent Treatment for Colorectal Liver Metastases. Ann Surg Oncol 2023; 30:3425-3426. [PMID: 36376571 DOI: 10.1245/s10434-022-12828-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Geoffrey Yuet Mun Wong
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, NSW, 2065, Australia.
- Northern Clinical School, The University of Sydney, Sydney, NSW, 2065, Australia.
| | - Connie Diakos
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, 2065, Australia
| | - Mark P Molloy
- Bowel Cancer and Biomarker Research Laboratory, Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Thomas J Hugh
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, NSW, 2065, Australia
- Northern Clinical School, The University of Sydney, Sydney, NSW, 2065, Australia
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2
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Wong GYM, Bhimani N, Mol B, Diakos C, de Reuver P, Molloy MP, Hugh TJ. Performance of prognostic models incorporating KRAS mutation status to predict survival after resection of colorectal liver metastases. HPB (Oxford) 2022; 24:1316-1325. [PMID: 35093297 DOI: 10.1016/j.hpb.2022.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/02/2021] [Accepted: 01/05/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Genetic And Morphologic Evaluation (GAME) score and modified clinical score (m-CS) are two novel prognostic models that incorporate KRAS mutation status to predict survival after resection of colorectal liver metastases (CRLM). This retrospective cohort study evaluated the performance of these two models. METHODS A total of 103 patients who underwent resection of CRLM between 2007 and 2017 and had known KRAS mutation status were included, 39 (37.9%) of whom had KRAS mutated tumours. Complete case analysis of the patients was performed according to the Clinical Risk Score (CRS), m-CS, and GAME score. The primary outcome was overall survival stratified according to low-risk and high-risk scores. Harrell's C-index and Akaike information criterion (AIC) were used to compare the discrimination of the evaluated prognostic models. RESULTS The GAME score demonstrated the largest difference in overall survival for patients stratified according to low-risk and high-risk groups. Harrell's C-index values for the CRS, m-CS, and GAME models were 0.583, 0.600, and 0.668, respectively. AIC values for the CRS, m-CS, and GAME models were 441, 439, and 427, respectively. CONCLUSION The GAME score outperforms the CRS and m-CS in predicting overall survival after resection of CRLM in patients with known KRAS mutation status.
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Affiliation(s)
- Geoffrey Yuet Mun Wong
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia; Department of Medical Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia.
| | - Nazim Bhimani
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Barend Mol
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Connie Diakos
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Philip de Reuver
- Department of Surgery, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Mark P Molloy
- Bowel Cancer and Biomarker Research Laboratory, School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Thomas J Hugh
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia; Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
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3
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Wong GYM, Mol B, Bhimani N, Reuver P, Diakos C, Molloy MP, Hugh TJ. Recurrence patterns predict survival after resection of colorectal liver metastases. ANZ J Surg 2022; 92:2149-2156. [PMID: 35666139 PMCID: PMC9544678 DOI: 10.1111/ans.17835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 03/13/2022] [Accepted: 05/22/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Geoffrey Yuet Mun Wong
- Department of Upper Gastrointestinal Surgery Unit Royal North Shore Hospital Sydney New South Wales Australia
- Northern Clinical School University of Sydney Sydney New South Wales Australia
| | - Barend Mol
- Department of Upper Gastrointestinal Surgery Unit Royal North Shore Hospital Sydney New South Wales Australia
| | - Nazim Bhimani
- Department of Upper Gastrointestinal Surgery Unit Royal North Shore Hospital Sydney New South Wales Australia
| | - Philip Reuver
- Department of Surgery Radboud University Medical Centre Nijmegen The Netherlands
| | - Connie Diakos
- Northern Clinical School University of Sydney Sydney New South Wales Australia
- Department of Medical Oncology Royal North Shore Hospital Sydney New South Wales Australia
| | - Mark P. Molloy
- Bowel Cancer and Biomarker Research Laboratory, School of Medical Sciences The University of Sydney Sydney New South Wales Australia
| | - Thomas J. Hugh
- Department of Upper Gastrointestinal Surgery Unit Royal North Shore Hospital Sydney New South Wales Australia
- Northern Clinical School University of Sydney Sydney New South Wales Australia
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4
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Wong GYM, Diakos C, Hugh TJ, Molloy MP. Proteomic Profiling and Biomarker Discovery in Colorectal Liver Metastases. Int J Mol Sci 2022; 23:ijms23116091. [PMID: 35682769 PMCID: PMC9181741 DOI: 10.3390/ijms23116091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/27/2022] [Accepted: 05/27/2022] [Indexed: 12/14/2022] Open
Abstract
Colorectal liver metastases (CRLM) are the leading cause of death among patients with metastatic colorectal cancer (CRC). As part of multimodal therapy, liver resection is the mainstay of curative-intent treatment for select patients with CRLM. However, effective treatment of CRLM remains challenging as recurrence occurs in most patients after liver resection. Proposed clinicopathologic factors for predicting recurrence are inconsistent and lose prognostic significance over time. The rapid development of next-generation sequencing technologies and decreasing DNA sequencing costs have accelerated the genomic profiling of various cancers. The characterisation of genomic alterations in CRC has significantly improved our understanding of its carcinogenesis. However, the functional context at the protein level has not been established for most of this genomic information. Furthermore, genomic alterations do not always result in predicted changes in the corresponding proteins and cancer phenotype, while post-transcriptional and post-translational regulation may alter synthesised protein levels, affecting phenotypes. More recent advancements in mass spectrometry-based technology enable accurate protein quantitation and comprehensive proteomic profiling of cancers. Several studies have explored proteomic biomarkers for predicting CRLM after oncologic resection of primary CRC and recurrence after curative-intent resection of CRLM. The current review aims to rationalise the proteomic complexity of CRC and explore the potential applications of proteomic biomarkers in CRLM.
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Affiliation(s)
- Geoffrey Yuet Mun Wong
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, NSW 2065, Australia;
- Northern Clinical School, The University of Sydney, Sydney, NSW 2065, Australia;
- Correspondence:
| | - Connie Diakos
- Northern Clinical School, The University of Sydney, Sydney, NSW 2065, Australia;
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW 2065, Australia
| | - Thomas J. Hugh
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, NSW 2065, Australia;
- Northern Clinical School, The University of Sydney, Sydney, NSW 2065, Australia;
| | - Mark P. Molloy
- Bowel Cancer and Biomarker Research Laboratory, Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, NSW 2006, Australia;
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5
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Siu DHW, Ali A, Tjokrowidjaja A, De Silva M, Lee J, Clingan PR, Aghmesheh M, Brungs D, Mapagu C, Goldstein D, O'Neill S, Liauw WS, Sjoquist KM, Thomas D, Pavlakis N, Clarke SJ, Diakos C, Chantrill LA. Clinical and molecular profile of young adults with early-onset colorectal cancer: Experience from four Australian tertiary centers. Asia Pac J Clin Oncol 2022; 18:660-668. [PMID: 35098672 DOI: 10.1111/ajco.13745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with early-onset colorectal cancer (EO-CRC) have unique characteristics. Contemporary data on the pathological and molecular features, and survival of EO-CRC are limited in the Australian context. AIM To determine the demographic, histopathological and molecular characteristics of adults with EO-CRC, and their survival. METHODS We conducted a retrospective study of adults aged 18-49 years with EO-CRC who were referred to the Illawarra Shoalhaven Local Health District, South Eastern Sydney Local Health District and Royal North Shore Hospital in New South Wales, Australia, between 2014 and 2018. RESULTS Of 257 patients included, 94 (37%) patients presented with de novo metastatic CRC, 80% patients had near-average risk family history and 89% had a symptomatic presentation. In 159 patients with nonmetastatic disease at diagnosis, stage III disease (OR 3.88 [95% CI: 1.13-13.3]; p = .03) and the presence of perineural invasion (PNI) (OR 6.63 [95% CI: 2.21-19.84]; p = .001) were risk factors associated with the development of metastatic disease. Among 94 patients with de novo metastatic disease, 43 (43%) and 12 (14%) patients harbored a KRAS or BRAF V600E mutation, respectively. The median overall survival was 29.6 months (95% CI: 20.4-38.7). BRAF mutation was associated with inferior survival (HR 3.00 [95% CI: 1.30-6.94]; p = .01). CONCLUSION The prevalence of KRAS and BRAF mutations in our cohort is similar to the overseas experience. Stage III disease at diagnosis, presence of PNI and BRAF mutation are adverse prognostic indicators. A better understanding of the molecular landscape is needed for this patient cohort, so as to better tailor prevention strategies, screening and treatment pathways.
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Affiliation(s)
- Derrick Ho Wai Siu
- Department of Medical Oncology, Illawarra Shoalhaven Local Health District (ISLHD), New South Wales, Australia.,Department of Medical Oncology, St George Hospital, New South Wales, Australia.,National Health and Medical Research Council (NHMRC) Clinical Trial Centre, University of Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Arwa Ali
- Department of Medical Oncology, Nelune Cancer Centre, The Prince of Wales Hospital (POWH), New South Wales, Australia.,Department of Medical Oncology, South Egypt Cancer Institute, Asyut, Egypt
| | - Angelina Tjokrowidjaja
- Department of Medical Oncology, St George Hospital, New South Wales, Australia.,National Health and Medical Research Council (NHMRC) Clinical Trial Centre, University of Sydney, New South Wales, Australia
| | - Madhawa De Silva
- Department of Medical Oncology, Royal North Shore Hospital (RNSH), New South Wales, Australia
| | - Joanna Lee
- Department of Medical Oncology, St George Hospital, New South Wales, Australia
| | - Philip R Clingan
- Department of Medical Oncology, Illawarra Shoalhaven Local Health District (ISLHD), New South Wales, Australia.,School of Medicine, University of Wollongong, New South Wales, Australia
| | - Morteza Aghmesheh
- Department of Medical Oncology, Illawarra Shoalhaven Local Health District (ISLHD), New South Wales, Australia.,School of Medicine, University of Wollongong, New South Wales, Australia
| | - Daniel Brungs
- Department of Medical Oncology, Illawarra Shoalhaven Local Health District (ISLHD), New South Wales, Australia.,School of Medicine, University of Wollongong, New South Wales, Australia
| | - Cristina Mapagu
- Department of Medical Oncology, Illawarra Shoalhaven Local Health District (ISLHD), New South Wales, Australia.,Westmead Clinical School, University of Sydney, New South Wales, Australia
| | - David Goldstein
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Department of Medical Oncology, Nelune Cancer Centre, The Prince of Wales Hospital (POWH), New South Wales, Australia
| | - Siobhan O'Neill
- Department of Medical Oncology, Nelune Cancer Centre, The Prince of Wales Hospital (POWH), New South Wales, Australia
| | - Winston S Liauw
- Department of Medical Oncology, St George Hospital, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Katrin M Sjoquist
- Department of Medical Oncology, St George Hospital, New South Wales, Australia.,National Health and Medical Research Council (NHMRC) Clinical Trial Centre, University of Sydney, New South Wales, Australia
| | - David Thomas
- Department of Medical Oncology, St George Hospital, New South Wales, Australia
| | - Nick Pavlakis
- Department of Medical Oncology, Royal North Shore Hospital (RNSH), New South Wales, Australia.,Northern Clinical School, University of Sydney, New South Wales, Australia
| | - Stephen J Clarke
- Department of Medical Oncology, Royal North Shore Hospital (RNSH), New South Wales, Australia.,Northern Clinical School, University of Sydney, New South Wales, Australia
| | - Connie Diakos
- Department of Medical Oncology, Royal North Shore Hospital (RNSH), New South Wales, Australia.,Northern Clinical School, University of Sydney, New South Wales, Australia
| | - Lorraine A Chantrill
- Department of Medical Oncology, Illawarra Shoalhaven Local Health District (ISLHD), New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,The Garvan Institute of Medical Research, Sydney, New South Wales, Australia
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6
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Wijetunga AR, Chua TC, Nahm CB, Pavlakis N, Clarke S, Chan DL, Diakos C, Maloney S, Ashrafi-Zadeh A, Kneebone A, Hruby G, Jamieson NB, Gill A, Mittal A, Samra JS. Survival in borderline resectable and locally advanced pancreatic cancer is determined by the duration and response of neoadjuvant therapy. Eur J Surg Oncol 2021; 47:2543-2550. [PMID: 33952409 DOI: 10.1016/j.ejso.2021.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/04/2021] [Accepted: 04/05/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Pancreatic cancer is the 8th commonest cancer and the 5th commonest cause of cancer-related death in Australia, with a 9% average 5-year survival. This study aims to investigate the effects of neoadjuvant treatment on overall survival (OS) and recurrence-free survival (RFS) in borderline resectable (BRPC) and locally advanced (LAPC) pancreatic adenocarcinoma followed by curative resection. MATERIALS AND METHODS Prospectively-collected demographic, medical, surgical and pathological data of patients with BRPC and LAPC treated with both neoadjuvant therapy (NAT) and surgery at a single tertiary referral centre in Australia were reviewed and analysed. RESULTS Between 2012 and 2018, 60 patients, 34 with BRPC and 26 with LAPC, were treated with NAT followed by curative resection. The commonest neoadjuvant chemotherapy regimens were Gemcitabine + Abraxane (51.7%) and FOLFIRINOX (35.0%), with 48.3% of patients additionally receiving neoadjuvant radiotherapy. Median RFS was 30 months and median OS was 35 months. On multivariable analysis, inferior OS was predicted by enlarged loco-regional lymph nodes on initial computed tomography (p = 0.032), larger tumour size post-NAT (p = 0.006) and Common Terminology Criteria for Adverse Events post-NAT toxicity greater than grade 2 (p = 0.015). LAPC patients received more neoadjuvant chemotherapy (p = 0.008) and radiotherapy (p = 0.021) than BRPC and achieved a superior pathological response (p = 0.010). CONCLUSION Patients who respond to NAT likely have a favourable disease biology and will progress well following resection. It is these patients who should be selected for more aggressive upfront management, and those with resistant disease should be spared from high-risk surgery.
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Affiliation(s)
| | - Terence C Chua
- School of Medicine, Griffith University, Gold Coast, QLD, Australia; Department of Surgery, QE II Jubilee Hospital, Brisbane, QLD, Australia
| | - Christopher B Nahm
- Sydney Medical School, The University of Sydney, Sydney, Australia; Department of Hepatopancreatobiliary Surgery, Westmead Hospital, Sydney, NSW, Australia
| | - Nick Pavlakis
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia; Australian Pancreatic Centre, St Leonards, Sydney, NSW, Australia
| | - Stephen Clarke
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia; Australian Pancreatic Centre, St Leonards, Sydney, NSW, Australia
| | - David L Chan
- Sydney Medical School, The University of Sydney, Sydney, Australia; Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia; Australian Pancreatic Centre, St Leonards, Sydney, NSW, Australia
| | - Connie Diakos
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia; Australian Pancreatic Centre, St Leonards, Sydney, NSW, Australia
| | - Sarah Maloney
- Sydney Medical School, The University of Sydney, Sydney, Australia; Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Amir Ashrafi-Zadeh
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Andrew Kneebone
- Australian Pancreatic Centre, St Leonards, Sydney, NSW, Australia; Department of Radiation Oncology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - George Hruby
- Australian Pancreatic Centre, St Leonards, Sydney, NSW, Australia; Department of Radiation Oncology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Nigel B Jamieson
- Institute of Cancer Sciences, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Anthony Gill
- Sydney Medical School, The University of Sydney, Sydney, Australia; Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia; NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Anubhav Mittal
- Sydney Medical School, The University of Sydney, Sydney, Australia; Australian Pancreatic Centre, St Leonards, Sydney, NSW, Australia; Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Jaswinder S Samra
- Sydney Medical School, The University of Sydney, Sydney, Australia; Australian Pancreatic Centre, St Leonards, Sydney, NSW, Australia; Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, Sydney, NSW, Australia
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7
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Yuile A, Fanuli C, van Nunen S, Diakos C, Clarke S, Steiner C, MacMillan R, Oatley M, Pavlakis N. Increased rates of cetuximab reactions in tick prevalent regions and a proposed protocol for risk mitigation. Asia Pac J Clin Oncol 2020; 17:448-453. [PMID: 32970939 DOI: 10.1111/ajco.13465] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/04/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cetuximab is an anti-epidermal growth factor receptor mouse-human chimeric monoclonal antibody used to treat advanced colorectal cancers. Initial data suggest that severe infusion reactions occurred in 4.5%, many on first exposure. The majority of those with anaphylactic reactions possess predeveloped IgE antibodies to galactose-alpha-1,3-galactose. It is thought that the vector for preexposure to alpha-gal is antigen inoculation via tick bites. This retrospective study reviews the experience of two community cancer centers in high tick exposure areas in Sydney with cetuximab anaphylaxis and proposes a protocol to avoid this. METHOD Severe cetuximab infusion reactions occurring in the Northern Cancer Institute Frenchs Forest and St Leonards clinics, Sydney, from May 2014 to February 2019 were recorded. Area of residence was then compared to areas of known high tick prevalence. RESULTS A total of 87 patients received cetuximab in this period. Six patients (6.9%) experienced at least a grade 3 reaction, three females, age range 41-72 years (median 57.5 years). All were receiving cetuximab for metastatic colorectal cancer and their anaphylaxis occurred with the first infusion in all cases. CONCLUSION These cases support the existing theory of increased rates of cetuximab anaphylaxis in areas of high tick prevalence. Given this, we recommend the following protocol for patients being considered for cetuximab therapy: known mammalian meat allergy as an absolute contraindication; all patients receiving cetuximab should have RAST (ImmunoCAP® ) testing for alpha-gal specific-IgE-specific antibodies before first infusion and those who test positive to be considered alternate therapy.
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Affiliation(s)
- Alexander Yuile
- Northern Cancer Institute, Sydney, New South Wales, Australia.,Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Claudia Fanuli
- Northern Cancer Institute, Sydney, New South Wales, Australia
| | - Sheryl van Nunen
- Northern Cancer Institute, Sydney, New South Wales, Australia.,Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Connie Diakos
- Northern Cancer Institute, Sydney, New South Wales, Australia.,Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Stephen Clarke
- Northern Cancer Institute, Sydney, New South Wales, Australia.,Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Christian Steiner
- Northern Cancer Institute, Sydney, New South Wales, Australia.,Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Robyn MacMillan
- Northern Cancer Institute, Sydney, New South Wales, Australia.,Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Meredith Oatley
- Northern Cancer Institute, Sydney, New South Wales, Australia.,Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Nick Pavlakis
- Northern Cancer Institute, Sydney, New South Wales, Australia.,Royal North Shore Hospital, Sydney, New South Wales, Australia
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8
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Fuchs TL, Pearson A, Pickett J, Diakos C, Dewar R, Chan D, Guminski A, Menzies A, Baron-Hay S, Sheen A, Sioson L, Chou A, Gill AJ. Why pathologists and oncologists should know about tumour-infiltrating lymphocytes (TILs) in triple-negative breast cancer: an Australian experience of 139 cases. Pathology 2020; 52:515-521. [PMID: 32553444 DOI: 10.1016/j.pathol.2020.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 03/30/2020] [Accepted: 04/05/2020] [Indexed: 12/23/2022]
Abstract
The presence of increased tumour infiltrating lymphocytes (TILs) is established as a positive prognostic factor in triple-negative breast cancer (TNBC). The majority of studies have examined the role of TILs in predicting response to chemotherapy, but their role as a general prognostic marker in TNBC is unclear. Moreover, there is a lack of consensus in the literature regarding a suitable cut-off point by which to stratify patients into prognostic groups. Therefore, we sought to confirm the prognostic value of TILs in an independent cohort of unselected TNBCs, and to determine an appropriate cut-off point by which to stratify TIL scores into prognostically significant categories. We used the International TILs Working Group (ITWG) methodology to assess the density of stromal TILs in our cohort of 139 TNBC patients undergoing curative resection at our institution. The percentage TILs scores were categorised first into three groups: low (0-10%), intermediate (15-50%), and high (55-100%). A second binary variable was also created by separating cases into low TILs (≤50%) and high TILs (>50%) groups. Using the three-tiered system, mean disease-free survival was 156, 99 and 94 months for the high, intermediate and low TILs groups, respectively (p=0.030). However, no statistically significant improvement was observed for overall survival. Using the two-tiered system, statistically significant improvements in both overall survival (p=0.030) and disease-free survival (p=0.010) were observed. This survival benefit remained statistically significant in multivariate analyses (p=0.010, p=0.014). We conclude that TILs scored using the ITWG system and dichotomised at a cut-off score of 50%, are a powerful predictor of all-cause and disease-free survival in TNBC regardless of chemotherapy treatment.
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Affiliation(s)
- Talia L Fuchs
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia; NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Antonia Pearson
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Oncology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Justine Pickett
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia; NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Connie Diakos
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Oncology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Robert Dewar
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - David Chan
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Oncology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Alexander Guminski
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Oncology, Royal North Shore Hospital, Sydney, NSW, Australia; Melanoma Institute, Wollstonecraft, NSW, Australia
| | - Alexander Menzies
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Oncology, Royal North Shore Hospital, Sydney, NSW, Australia; Melanoma Institute, Wollstonecraft, NSW, Australia
| | - Sally Baron-Hay
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Oncology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Amy Sheen
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Loretta Sioson
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Angela Chou
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia; NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Anthony J Gill
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia; NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
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9
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McKelvey K, Hudson A, Kumar R, Long G, Scolyer R, Wilmott J, Attrill G, Clarke S, Wheeler H, Diakos C, Howell V. IMMU-04. TEMPORAL AND SPATIAL MODULATION OF THE IMMUNE RESPONSE OF THE MURINE GL261 GLIOMA TUMOUR MICROENVIRONMENT. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
INTRODUCTION
Glioma is a debilitating and early fatal cancer arising in the glial cells of brain. Glioblastoma, the most aggressive form of gliomas, has a 5-year survival rate of 5% with treatment options limited to surgery, radiotherapy or chemotherapy with temozolomide.
OBJECTIVE
While radiation and immunotherapies are routinely studied in the murine Gl261 glioma model, little is known about its inherent immune response. In this study we quantified the temporal and spatial localisation of immune cell populations and mediators during glioma development.
METHODS
Mice were inoculated with 1x106 Gl261 cells at AP0.1mm, ML1.0mm, DV2.6mm Bregma. Tumour morphology, local and systemic immune cell populations were assessed at Day-0, 1, 3, 7, 14, and 21 post-inoculation by MRI, immunohistochemistry for Ki67+ proliferation and CD31+ vessel density; local immune infiltrate by multiplex immunofluorescence (VECTRA®;PerkinElmer); systemic immunity in spleen, bone marrow and peripheral blood by 16-parameter flow cytometry (LSRFortessa™;BD Biosciences); and multiplex immunoassay (Bio-Plex®;Bio-Rad) for plasma cytokines/chemokines.
RESULTS
From Day-3 tumours were distinguishable with high Ki67+ (> 30%) and increased tissue vascularisation (26.38±1.45 vessels/field; p< 0.05). Ki67 remained high until Day-21 with visible necrotic regions, increased vessel density and lumen area within tumour region. Increasing tumour proliferation/malignancy and vascularisation were associated with significant temporal changes in immune cell populations within the tumour (p< 0.05) and systemic compartments (p=0.02- p< 0.0001). Of note, at Day-14 NK, M1, PMN-MDSCs and M-MDSCs in the tumour infiltrate declined, coinciding with a decrease in 16/24 plasma cytokine/chemokines levels. Tumour infiltrating immune cell populations did not correlate with peripheral blood populations. However, a decrease in plasma cytokine/chemokine levels may indicate ‘immune exhaustion’.
CONCLUSIONS
The data derived provide baseline characteristics to study changes associated with multi-modal treatment strategies and to sequence therapies to maintain immune modulation. This information will contribute to the identification of novel combination therapies.
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Affiliation(s)
- Kelly McKelvey
- Bill Walsh Translational Cancer Research Laboratory, The University of Sydney Northern Clinical School & Northern Sydney Local Health District Research (Kolling Institute of Medical Research), St Leonards, NSW, Australia
| | - Amanda Hudson
- Bill Walsh Translational Cancer Research Laboratory, The University of Sydney Northern Clinical School & Northern Sydney Local Health District Research (Kolling Institute of Medical Research), St Leonards, NSW, Australia
| | - Ramyashree Kumar
- Bill Walsh Translational Cancer Research Laboratory, The University of Sydney Northern Clinical School & Northern Sydney Local Health District Research (Kolling Institute of Medical Research), St Leonards, NSW, Australia
| | - Georgina Long
- Melanoma Institute Australia & Mater Hospital, North Sydney, NSW, Australia
| | - Richard Scolyer
- Melanoma Institute Australia & Royal Prince Alfred Hospital, North Sydney, NSW, Australia
| | - James Wilmott
- Melanoma Institute Australia, North Sydney, NSW, Australia
| | - Grace Attrill
- Melanoma Institute Australia, North Sydney, NSW, Australia
| | - Stephen Clarke
- Bill Walsh Translational Cancer Research Laboratory, The University of Sydney Northern Clinical School & Northern Sydney Local Health District Research (Kolling Institute of Medical Research), St Leonards, NSW, Australia
| | - Helen Wheeler
- Bill Walsh Translational Cancer Research Laboratory, The University of Sydney Northern Clinical School & Northern Sydney Local Health District Research (Kolling Institute of Medical Research), St Leonards, NSW, Australia
| | - Connie Diakos
- Bill Walsh Translational Cancer Research Laboratory, The University of Sydney Northern Clinical School & Northern Sydney Local Health District Research (Kolling Institute of Medical Research), St Leonards, NSW, Australia
| | - Viive Howell
- Bill Walsh Translational Cancer Research Laboratory, The University of Sydney Northern Clinical School & Northern Sydney Local Health District Research (Kolling Institute of Medical Research), St Leonards, NSW, Australia
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Tu H, Xu C, Tong-Li C, Offin M, Razavi P, Schapira E, Namakydoust A, Lee A, Pavlakis N, Clarke S, Diakos C, Chan D, Myers M, Makhnin A, Jain H, Martinez A, Iqbal Z, Adamski A, Li H, Hernandez J, Watford S, Hosseini A, Shaffer T, Lim L, Li M, Drilon A, Ladanyi M, Arcila M, Rusch V, Jones D, Rudin C, Rimner A, Isbell J, Li B. P1.01-122 A Clinical Utility Study of Plasma DNA Next Generation Sequencing Guided Treatment of Uncommon Drivers in Advanced Non-Small-Cell Lung Cancers. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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11
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McKelvey K, Hudson A, Wheeler H, Diakos C, Howell V. TMIC-39. UNRAVELLING THE TUMOUR MICROENVIRONMENT OF GLIOMA. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.1098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kelly McKelvey
- Bill Walsh Translational Cancer Laboratory, The University of Sydney Northern Clinical School, Faculty of Health and Medicine; Northern Sydney Local Heath District Research (Kolling Institute); Sydney Vital Translational Research Centre, St Leonards, NSW, Australia
| | - Amanda Hudson
- Bill Walsh Translational Cancer Laboratory, The University of Sydney Northern Clinical School, Faculty of Health and Medicine; Northern Sydney Local Heath District Research (Kolling Institute); Sydney Vital Translational Research Centre, St Leonards, NSW, Australia
| | - Helen Wheeler
- Bill Walsh Translational Cancer Laboratory, The University of Sydney Northern Clinical School, Faculty of Health and Medicine; Northern Sydney Local Heath District Research (Kolling Institute), St Leonards, NSW, Australia
| | - Connie Diakos
- Bill Walsh Translational Cancer Laboratory, The University of Sydney Northern Clinical School, Faculty of Health and Medicine; Northern Sydney Local Heath District Research (Kolling Institute); Sydney Vital Translational Research Centre, St Leonards, NSW, Australia
| | - Viive Howell
- Bill Walsh Translational Cancer Laboratory, The University of Sydney Northern Clinical School, Faculty of Health and Medicine; Northern Sydney Local Heath District Research (Kolling Institute); Sydney Vital Translational Research Centre, St Leonards, NSW, Australia
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12
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McKelvey K, Hudson A, Wheeler H, Diakos C, Howell V. P04.18 Unravelling the tumour microenvironment of glioma. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- K McKelvey
- Bill Walsh Translational Cancer Laboratory, The University of Sydney Northern Clinical School, Faculty of Health and Medicine; Northern Sydney Local Heath District Research (Kolling Institute); Sydney Vital Translational Research Centre, St Leonards, Australia
- Mark Hughes Foundation, Hunter Medical Research Institute, New Lambton Heights, Australia
| | - A Hudson
- Bill Walsh Translational Cancer Laboratory, The University of Sydney Northern Clinical School, Faculty of Health and Medicine; Northern Sydney Local Heath District Research (Kolling Institute); Sydney Vital Translational Research Centre, St Leonards, Australia
- The Brain Cancer Group, North Shore Private Hospital, St Leonards, Australia
| | - H Wheeler
- Bill Walsh Translational Cancer Laboratory, The University of Sydney Northern Clinical School, Faculty of Health and Medicine; Northern Sydney Local Heath District Research (Kolling Institute); Sydney Vital Translational Research Centre, St Leonards, Australia
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Australia
| | - C Diakos
- Bill Walsh Translational Cancer Laboratory, The University of Sydney Northern Clinical School, Faculty of Health and Medicine; Northern Sydney Local Heath District Research (Kolling Institute); Sydney Vital Translational Research Centre, St Leonards, Australia
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Australia
| | - V Howell
- Bill Walsh Translational Cancer Laboratory, The University of Sydney Northern Clinical School, Faculty of Health and Medicine; Northern Sydney Local Heath District Research (Kolling Institute); Sydney Vital Translational Research Centre, St Leonards, Australia
- The Brain Cancer Group, North Shore Private Hospital, St Leonards, Australia
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13
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Vafaee F, Diakos C, Kirschner MB, Reid G, Michael MZ, Horvath LG, Alinejad-Rokny H, Cheng ZJ, Kuncic Z, Clarke S. A data-driven, knowledge-based approach to biomarker discovery: application to circulating microRNA markers of colorectal cancer prognosis. NPJ Syst Biol Appl 2018; 4:20. [PMID: 29872543 PMCID: PMC5981448 DOI: 10.1038/s41540-018-0056-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 04/11/2018] [Accepted: 05/04/2018] [Indexed: 02/08/2023] Open
Abstract
Recent advances in high-throughput technologies have provided an unprecedented opportunity to identify molecular markers of disease processes. This plethora of complex-omics data has simultaneously complicated the problem of extracting meaningful molecular signatures and opened up new opportunities for more sophisticated integrative and holistic approaches. In this era, effective integration of data-driven and knowledge-based approaches for biomarker identification has been recognised as key to improving the identification of high-performance biomarkers, and necessary for translational applications. Here, we have evaluated the role of circulating microRNA as a means of predicting the prognosis of patients with colorectal cancer, which is the second leading cause of cancer-related death worldwide. We have developed a multi-objective optimisation method that effectively integrates a data-driven approach with the knowledge obtained from the microRNA-mediated regulatory network to identify robust plasma microRNA signatures which are reliable in terms of predictive power as well as functional relevance. The proposed multi-objective framework has the capacity to adjust for conflicting biomarker objectives and to incorporate heterogeneous information facilitating systems approaches to biomarker discovery. We have found a prognostic signature of colorectal cancer comprising 11 circulating microRNAs. The identified signature predicts the patients' survival outcome and targets pathways underlying colorectal cancer progression. The altered expression of the identified microRNAs was confirmed in an independent public data set of plasma samples of patients in early stage vs advanced colorectal cancer. Furthermore, the generality of the proposed method was demonstrated across three publicly available miRNA data sets associated with biomarker studies in other diseases.
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Affiliation(s)
- Fatemeh Vafaee
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW 2033 Australia
| | - Connie Diakos
- Kolling Institute of Medical Research, University of Sydney, Royal North Shore Hospital, Reserve Road, St Leonards, NSW 2065 Australia
| | | | - Glen Reid
- Asbestos Diseases Research Institute, Hospital Road, Concord, NSW 2139 Australia
- Sydney Medical School, University of Sydney, Sydney, NSW 2050 Australia
| | - Michael Z. Michael
- Flinders Centre for Innovation in Cancer, Flinders Medical Centre, Flinders University, Adelaide, SA 5042 Australia
| | - Lisa G. Horvath
- Sydney Medical School, University of Sydney, Sydney, NSW 2050 Australia
- Chris O’Brien Lifehouse, Missenden Road, Camperdown, NSW 2050 Australia
- Royal Prince Alfred Hospital, Camperdown, NSW 2050 Australia
| | | | - Zhangkai Jason Cheng
- Charles Perkins Centre, University of Sydney, Sydney, NSW 2006 Australia
- School of Physics, University of Sydney, Sydney, NSW 2006 Australia
| | - Zdenka Kuncic
- Charles Perkins Centre, University of Sydney, Sydney, NSW 2006 Australia
- School of Physics, University of Sydney, Sydney, NSW 2006 Australia
| | - Stephen Clarke
- Kolling Institute of Medical Research, University of Sydney, Royal North Shore Hospital, Reserve Road, St Leonards, NSW 2065 Australia
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14
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Itchins M, Arena J, Nahm CB, Rabindran J, Kim S, Gibbs E, Bergamin S, Chua TC, Gill AJ, Maher R, Diakos C, Wong M, Mittal A, Hruby G, Kneebone A, Pavlakis N, Samra J, Clarke S. Retrospective cohort analysis of neoadjuvant treatment and survival in resectable and borderline resectable pancreatic ductal adenocarcinoma in a high volume referral centre. Eur J Surg Oncol 2017; 43:1711-1717. [PMID: 28688722 DOI: 10.1016/j.ejso.2017.06.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 05/28/2017] [Accepted: 06/09/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Pancreatic ductal adenocarcinoma (PDAC) is a deadly disease. Neoadjuvant therapy (NA) with chemotherapy (NAC) and radiotherapy (RT) prior to surgery provides promise. In the absence of prospective data, well annotated clinical data from high-volume units may provide pilot data for randomised trials. METHODS Medical records from a tertiary hospital in Sydney, Australia, were analysed to identify all patients with resectable or borderline resectable PDAC. Data regarding treatment, toxicity and survival were collected. RESULTS Between January 1 2010 and April 1 2016, 220 sequential patients were treated: 87 with NA and 133 with upfront operation (UO). Forty-three NA patients (52%) and 5 UO patients (4%) were borderline resectable at diagnosis. Twenty-four borderline patients received NA RT, 22 sequential to NAC. The median overall survival (OS) in the NA group was 25.9 months (mo); 95% CI (21.1-43.0 mo) compared to 26.9 mo (19.7, 32.7) in the UO; HR 0.89; log-ranked p-value = 0.58. Sixty-nine NA patients (79%) were resected, mOS was 29.2 mo (22.27, not reached (NR)). Twenty-two NA (31%) versus 22 UO (17%) were node negative at operation (N0). In those managed with NAC/RT the mOS was 29.0 mo (17.3, NR). There were no post-operative deaths with NA within 90-days and three in the UO arm. DISCUSSION This is a hypothesis generating retrospective review of a selected real-world population in a high-throughput unit. Treatment with NA was well tolerated. The long observed survival in this group may be explained by lymph node sterilisation by NA, and the achievement of R0 resection in a greater proportion of patients.
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Affiliation(s)
- M Itchins
- Department of Oncology, Royal North Shore Hospital, Sydney, NSW, Australia; Sydney Medical School (Northern), The University of Sydney, Australia.
| | - J Arena
- Department of Oncology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - C B Nahm
- Upper GI Surgical Unit, Department of Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, NSW, Australia; Sydney Medical School (Northern), The University of Sydney, Australia
| | - J Rabindran
- Upper GI Surgical Unit, Department of Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, NSW, Australia; Sydney Medical School (Northern), The University of Sydney, Australia
| | - S Kim
- Upper GI Surgical Unit, Department of Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, NSW, Australia
| | - E Gibbs
- National Health and Medical Research Council Clinical Trial Centre (NHMRC CTC), The University of Sydney, Australia
| | - S Bergamin
- Department of Oncology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - T C Chua
- Upper GI Surgical Unit, Department of Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, NSW, Australia
| | - A J Gill
- Sydney Medical School (Northern), The University of Sydney, Australia; Cancer Diagnosis and Pathology, Kolling Institute, Royal North Shore Hospital, Sydney, Australia
| | - R Maher
- Department of Radiology, Royal North Shore Hospital, Australia
| | - C Diakos
- Department of Oncology, Royal North Shore Hospital, Sydney, NSW, Australia; Sydney Medical School (Northern), The University of Sydney, Australia; Northern Cancer Institute, Sydney, NSW, Australia
| | - M Wong
- Department of Medical Oncology, Gosford Hospital, New South Wales, Australia
| | - A Mittal
- Upper GI Surgical Unit, Department of Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, NSW, Australia; Sydney Medical School (Northern), The University of Sydney, Australia
| | - G Hruby
- Department of Oncology, Royal North Shore Hospital, Sydney, NSW, Australia; Sydney Medical School (Northern), The University of Sydney, Australia
| | - A Kneebone
- Department of Oncology, Royal North Shore Hospital, Sydney, NSW, Australia; Sydney Medical School (Northern), The University of Sydney, Australia
| | - N Pavlakis
- Department of Oncology, Royal North Shore Hospital, Sydney, NSW, Australia; Sydney Medical School (Northern), The University of Sydney, Australia; Northern Cancer Institute, Sydney, NSW, Australia
| | - J Samra
- Upper GI Surgical Unit, Department of Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, NSW, Australia; Sydney Medical School (Northern), The University of Sydney, Australia
| | - S Clarke
- Department of Oncology, Royal North Shore Hospital, Sydney, NSW, Australia; Sydney Medical School (Northern), The University of Sydney, Australia; Northern Cancer Institute, Sydney, NSW, Australia
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15
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Chan DLH, Pavlakis N, Schembri GP, Bernard EJ, Hsiao E, Hayes A, Barnes T, Diakos C, Khasraw M, Samra J, Eslick E, Roach PJ, Engel A, Clarke SJ, Bailey DL. Dual Somatostatin Receptor/FDG PET/CT Imaging in Metastatic Neuroendocrine Tumours: Proposal for a Novel Grading Scheme with Prognostic Significance. Am J Cancer Res 2017; 7:1149-1158. [PMID: 28435454 PMCID: PMC5399582 DOI: 10.7150/thno.18068] [Citation(s) in RCA: 180] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 12/17/2016] [Indexed: 02/06/2023] Open
Abstract
Background: PET scans using FDG and somatostatin receptor imaging agents have both been used to study neuroendocrine tumours. Most reports have documented the sensitivity and specificity of each radiopharmaceutical independently, and even suggested the superiority of one over the other for different grades of disease. Aim: The aim of this work was to develop a grading scheme that describes the joint results of both the FDG and somatostatin receptor imaging PET scans in staging subjects with neuroendocrine tumours in a single combined parameter. The grading scheme that has been developed is referred to as the NETPET grade. Methods: This is a retrospective study which assessed subjects who had both FDG and somatostatin receptor PET imaging at our institution within 31 days of each other. The NETPET grade was assigned by experienced nuclear medicine physicians and compared with other clinical data such as WHO grade and overall survival. Results: In the period 2011-2015 we were able to recruit 62 subjects with histologically proven metastatic neuroendocrine tumour for review. The NETPET grade incorporating both the FDG and somatostatin receptor imaging results was significantly correlated with overall survival by univariate analysis (p=0.0018), whereas in this cohort the WHO grade at the time of diagnosis did not correlate with survival. Conclusions: The NETPET grade has promise as a prognostic imaging biomarker in neuroendocrine tumours. It permits the capturing of the complexity of dual radiotracer imaging in a single parameter which describes the subjects' disease and is readily amenable to use in patient management and further research.
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16
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Selinger C, Cooper W, Lum T, McNeil C, Morey A, Waring P, Amanuel B, Millward M, Peverall J, Van Vliet C, Christie M, Tran Y, Diakos C, Pavlakis N, Gill AJ, O'Toole S. EquivocalALKfluorescencein-situhybridization (FISH) cases may benefit from ancillaryALKFISH probe testing. Histopathology 2015; 67:654-63. [DOI: 10.1111/his.12708] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 03/29/2015] [Indexed: 01/27/2023]
Affiliation(s)
- Christina Selinger
- Tissue Pathology and Diagnostic Oncology; Royal Prince Alfred Hospital; Camperdown NSW Australia
| | - Wendy Cooper
- Tissue Pathology and Diagnostic Oncology; Royal Prince Alfred Hospital; Camperdown NSW Australia
- School of Medicine; University of Western Sydney; Campbelltown NSW Australia
- Sydney Medical School; University of Sydney; Sydney NSW Australia
| | - Trina Lum
- Tissue Pathology and Diagnostic Oncology; Royal Prince Alfred Hospital; Camperdown NSW Australia
| | - Catriona McNeil
- Chris O'Brien Lifehouse and Royal Prince Alfred Hospital; Camperdown NSW Australia
| | - Adrienne Morey
- SydPath, Anatomical Pathology; St Vincent's Hospital; Darlinghurst NSW Australia
| | - Paul Waring
- Department of Pathology; University of Melbourne; Melbourne Vic. Australia
| | - Benhur Amanuel
- PathWest; Sir Charles Gairdner Hospital; Nedlands WA Australia
- School of Pathology and Laboratory Medicine; University of Western Australia; Nedlands WA Australia
| | - Michael Millward
- School of Medicine and Pharmacology; University of Western Australia; Nedlands WA Australia
- Department of Medical Oncology; Sir Charles Gairdner Hospital; Nedlands WA Australia
| | - Joanne Peverall
- PathWest; Sir Charles Gairdner Hospital; Nedlands WA Australia
| | - Chris Van Vliet
- PathWest; Sir Charles Gairdner Hospital; Nedlands WA Australia
- School of Pathology and Laboratory Medicine; University of Western Australia; Nedlands WA Australia
| | - Michael Christie
- Department of Pathology; University of Melbourne; Melbourne Vic. Australia
- Department of Anatomical Pathology and Medical Oncology; The Royal Melbourne Hospital; Parkville Vic. Australia
| | - Yen Tran
- Ballarat Base Hospital; Ballarat Vic. Australia
| | - Connie Diakos
- Royal North Shore Hospital; St Leonards NSW Australia
| | - Nick Pavlakis
- Royal North Shore Hospital; St Leonards NSW Australia
| | - Anthony J Gill
- Sydney Medical School; University of Sydney; Sydney NSW Australia
- Royal North Shore Hospital; St Leonards NSW Australia
- Cancer Diagnosis and Pathology Research Group; Kolling Institute of Medical Research; St Leonards NSW Australia
| | - Sandra O'Toole
- Tissue Pathology and Diagnostic Oncology; Royal Prince Alfred Hospital; Camperdown NSW Australia
- The Kinghorn Cancer Centre; Garvan Institute of Medical Research; Darlinghurst NSW Australia
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Säemann MD, Diakos C, Staffler G, Böhmig GA, Osterreicher CH, Stockinger H, Zlabinger GJ. Modulation of primary T cell responses and tolerance induction by tyrphostin AG490. Transplant Proc 2001; 33:132-3. [PMID: 11266742 DOI: 10.1016/s0041-1345(00)01938-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- M D Säemann
- Institute of Immunology, Department of Internal Medicine III, University of Vienna, Vienna, Austria
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18
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Diakos C, Prieschl E, Säemann M, Böhmig G, Baumruker T, Zlabinger G. Selective inhibition of NF-AT DNA binding by the short-chain fatty acid n-butyrate. Transplant Proc 2001; 33:197-8. [PMID: 11266777 DOI: 10.1016/s0041-1345(00)01973-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- C Diakos
- Institute of Immunology, Department of Internal Medicine III, University of Vienna, Vienna, Austria
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Säemann MD, Böhmig GA, Osterreicher CH, Burtscher H, Parolini O, Diakos C, Stöckl J, Hörl WH, Zlabinger GJ. Anti-inflammatory effects of sodium butyrate on human monocytes: potent inhibition of IL-12 and up-regulation of IL-10 production. FASEB J 2000; 14:2380-2. [PMID: 11024006 DOI: 10.1096/fj.00-0359fje] [Citation(s) in RCA: 319] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cytokines are critical in regulating unresponsiveness versus immunity towards enteric antigens derived from the intestinal flora and ingested food. There is increasing evidence that butyrate, a major metabolite of intestinal bacteria and crucial energy source for gut epithelial cells, also possesses anti-inflammatory properties. Its influence on cytokine production, however, is not established. Here, we report that butyrate strongly inhibits interleukin-12 (IL-12) production by suppression of both IL-12p35 and IL-12p40 mRNA accumulation, but massively enhances IL-10 secretion in Staphylococcus aureus cell-stimulated human monocytes. The effect of butyrate on IL-12 production was irreversible upon the addition of neutralizing antibodies to IL-10 or transforming growth factor b1 and of indomethacin. In anti-CD3-stimulated peripheral blood mononuclear cells, butyrate enhanced IL-10 and IL-4 secretion but reduced the release of IL-2 and interferon-g. The latter effect was in part a result of suppressed IL-12 production but also a result of inhibition of IL-12 receptor expression on T cells. These data demonstrate a novel anti-inflammatory property of butyrate that may have broad implications for the regulation of immune responses in vivo and could be exploited as new therapeutic approach in inflammatory conditions.
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Affiliation(s)
- M D Säemann
- Institute of Immunology, University of Vienna, Austria
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20
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Säemann MD, Böhmig GA, Osterreicher CH, Staffler G, Diakos C, Krieger PM, Hörl WH, Stockinger H, Zlabinger GJ. Suppression of primary T-cell responses and induction of alloantigen-specific hyporesponsiveness in vitro by the Janus kinase inhibitor tyrphostin AG490. Transplantation 2000; 70:1215-25. [PMID: 11063344 DOI: 10.1097/00007890-200010270-00016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Tyrphostin AG490 has recently been shown to block interleukin (IL)-2 receptor gamma-chain-associated Janus kinase 3. Here, we analyzed the effect of AG490 on T-cell alloresponses in vitro. METHODS For the evaluation of T-cell activation, DNA synthesis, surface marker expression, cytokine secretion, intracellular calcium mobilization, early protein tyrosine phosphorylation, and apoptosis were measured. RESULTS AG490 effectively inhibited T-cell proliferation in human mixed lymphocyte culture (MLC) even when added 4 days after culture initiation. Inhibition of IL-2-dependent proliferation in T-cell blasts and the incapability of IL-2 or IL-15 to restore proliferation in AG490-treated MLC suggests interference with cytokine receptor signaling. T-cell receptor-triggered early protein tyrosine phosphorylation, calcium mobilization, up-regulation of CD69, and initial CD25 expression were not affected. Interestingly, AG490 substantially inhibited production of IL-2 and interferon-gamma in T cells stimulated with alloantigen or via CD3 and CD28. In CD28-independent activation models (e.g., stimulation with phorbol myristate acetate plus ionomycin), however, cytokine secretion was not inhibited. Pretreatment of primary MLC with AG490 resulted in substantial down-regulation of secondary responses to cells from the original donor as opposed to third-party cells or phytohemagglutinin. Unresponsiveness was induced also in T cells stimulated with CD3 monoclonal antibody. Induction of apoptosis in polyclonally activated T cells and the incapability of IL-2 to reverse specific hyporesponsiveness, suggest programmed cell death as an important mechanism underlying antigen-specific down-regulation of alloresponses. CONCLUSIONS We demonstrate that AG490 blocks different manifestations of T-cell activation. This and its ability to induce alloantigen-specific hyporesponsiveness point to a potential use for interfering with alloreactivities in vivo.
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Affiliation(s)
- M D Säemann
- Institute of Immunology and Department of Internal Medicine III, University of Vienna, Austria
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